Icd 10 Mental And Behavioural Disorders PdfBy Peter N. In and pdf 10.04.2021 at 14:08 7 min read
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Chapter V .
International Journal of Clinical and Health Psychology publishes manuscripts with a basic and applied emphasis, involving both theoretical and experimental areas contributing to the advancement of Clinical and Health Psychology. Papers including psychopathology, psychotherapy, behaviour therapy, cognitive therapies, behavioural medicine, health psychology, community mental health, sexual health, child development, psychological assessment, psychophysiology, neuropsychology, etc.
On exception the Journal publishes articles on science evaluation. The manuscripts with samples of university students whose use is not clearly justified in the objectives of the study will not be considered. The manuscripts submitted to International Journal of Clinical and Health Psychology should not have been previously published, and should not be under consideration for publication elsewhere.
All signing authors must agree on the submitted version of the manuscript. By submitting their manuscript the authors agree to relinquish their copyrights to the Journal for the duration of the editorial process. Copyrights will be transferred permanently to International Journal of Clinical and Health Psychology if the manuscript is accepted for publication. The Impact Factor measures the average number of citations received in a particular year by papers published in the journal during the two receding years.
CiteScore measures average citations received per document published. Read more. SRJ is a prestige metric based on the idea that not all citations are the same. SJR uses a similar algorithm as the Google page rank; it provides a quantitative and qualitative measure of the journal's impact. SNIP measures contextual citation impact by wighting citations based on the total number of citations in a subject field. The objective is evaluate the inter-rater reliability and clinical utility of ICD guidelines for psychotic, mood, anxiety- and stress-related disorders in Mexican patients.
Method: Adult volunteers exhibiting the selected symptoms were referred from the pre-consultation unit of a public psychiatric hospital to an interview by a pair of clinicians, who subsequently assigned independent diagnoses and evaluated the clinical utility of the diagnostic guidelines as applied to each particular case, on the basis of a scale developed for this purpose.
Results: 23 clinicians evaluated patients. Kappa scores were strong for psychotic disorders. A high proportion of clinicians considered all diagnostic guidelines to be quite to extremely useful as applied to their patients.
Conclusions: ICD guidelines for psychotic, stress-related and mood disorders allow adequate inter-rater consistency among Mexican clinicians, who also considered them as clinical useful tools.. The guidelines were subsequently modified on the basis of the results of these studies, with the WHO expert WG suggesting the modifications and overseeing the process. The next step was to test the guidelines and their impact on decision-making in real settings in order to confirm that they do in fact lead to improvements in diagnostic practice in clinical settings around the world.
Having reliable guidelines with a high level of clinical utility Reed, supports WHO's overarching aim of reducing the disease burden of mental and behavioral disorders International Advisory Group for the Revision of ICD Mental and Behavioural Disorders, For the guidelines to be considered clinically useful, they should be accurately and easily used by practitioners Reed et al.
In Latin America, implementation of the ICD diagnostic guidelines will take place in a particular context. In this region, years lived with disability due to depression range from Recent decades have seen an increase in violence in many countries, two Honduras and Venezuela of which are ranked as having the first and second highest homicide rates worldwide United Nations Office ond Drugs and Crime UNODC, Violence is linked to both mental disorders and suicide Benjet, Borges, G.
In Mexico, according to the latest Psychiatric Epidemiology Survey, approximately one in four adults between the ages of 18 and 65 living in urban areas have had a mental disorder at some time in their lives, with anxiety and depression being the most common Prevalence rates in Mexico rank around the median among countries that are part of the World Mental Health Surveys Kessler et al.
This highlights the urgent need for the timely identification of cases requiring treatment. Nowadays, some of such limitations could be addressed in certain ways as part of the revision and improvement of a nosology system, while other would depend on the future state of understanding of the brain, particularly its higher functions. This paper shows the results of the ecological studies to test the proposed ICD guidelines for non-psychotic and psychotic adult patients presenting for care at a tertiary public mental health facility in Mexico.
Its principal aim was to show the value of the diagnostic guidelines in informing practitioners about the specific diagnosis of their patients, their implementation characteristics goodness of fit, ease of use and time required to apply them and their utility in selecting interventions and making clinical management decisions Reed, This was done by determining inter-rater consistency in diagnoses and the clinical utility of the proposed ICD diagnostic guidelines for the ICD groups of disorders that account for the largest share of the disease burden of mental disorders and the major proportion of service utilization in mental health settings: 1 Schizophrenia and Other Primary Psychotic Disorders; 2 Mood Disorders; 3 Anxiety and Fear-Related Disorders; and 4 Disorders Specifically Associated with Stress.
This was a cross-sectional study, drawing on a sample of participants seeking mental health services in a public, specialized, mental health care setting in Mexico City, Mexico.
It follows the study design developed by our international group Reed et al. Alternative methods, such as using independent interviews, would not control for variability in case presentations over time and information variance and would therefore be unable to provide specific information on how to improve diagnostic guidelines, the core purpose of this study.
We are less interested in inter-rater reliability as a statistic and more interested in the consistency of implementation of diagnostic guidelines in circumstances where diagnostic verdicts would be the same if the guidelines were error-free. Patients with: 1 psychotic symptoms; or 2 mood, anxiety, or stress-related symptoms without psychotic symptoms were identified by a clinician working at the outpatient psychiatric service.
Identification was based on the normal intake interview performed by a second-year psychiatry resident; the intake interview is basically intended to triage patients. The information yielded by these interviews includes sociodemographic data, current reason for consultation, basic information about the course and clinical presentation of the problem, which was used to select the protocol for the patient.
In the presence of psychotic symptoms, the patient was referred to protocol 1, and in the presence of mood, anxiety or stress-related symptoms without psychotic symptoms, the patient was referred to protocol 2.
We used this screening procedure to select an enriched sample of study participants likely to display the conditions that were the focus of the study Reed et al. After receiving a comprehensive explanation of the nature and aims of the study, and giving their written informed consent, all participants were interviewed simultaneously by two clinicians.
One clinician in the pair was designated as the primary interviewer for that particular patient and the other as the observer.
Clinician raters were psychiatrists, or fifth-year psychiatry residents actively engaged in clinical work i. All clinician raters participated in a half-day training session on the diagnostic guidelines and study procedures. ICD diagnostic guidelines for the four disorder groups included in the study were provided to participating clinicians, who were asked to read them in detail prior to the face-to-face training session.
The training curriculum and materials used for the face-to-face training, developed by WHO, comprised a presentation of the innovations proposed for the ICD diagnostic guidelines for each diagnostic group included and the main conceptual features of the diagnostic guidelines for each category. As part of the training, clinician raters practiced applying the diagnostic guidelines to case vignettes, and discussed the issues that arose during this process.
Clinician raters were also provided with information on the study purpose, rationale, and methods, including a tutorial on how to use the Electronic Field Study System for data entry. The local Institutional Ethics Review Board approved all the procedures used as a part of this study, including the consent forms for both service users and clinicians. Although clinician raters had not been informed of any diagnostic formulation made by the referring clinician before conducting their diagnostic interview, they were provided with a brief clinical summary of the participant prepared by the second-year resident conducting the triage intake interview that did not include diagnoses or psychotropic medications.
During the training, clinician raters were informed that they could also review other clinical information on the patients if necessary and available including laboratory tests and brain images , with the proviso that both clinicians should look at the same information. Clinician raters then conducted a diagnostic interview of the participant in the way they deemed most appropriate.
No specific instructions were provided for the interview except that in Protocol 1 participants with psychotic symptoms , they should ensure they assessed Schizophrenia and Other Primary Psychotic Disorder, and in Protocol 2 participants without psychotic symptoms but with affective, anxiety- or stress-related symptoms , they should ensure they assessed Mood Disorders, Anxiety and Fear-Related Disorders, and Disorders Specifically Associated with Stress.
They were also instructed to assess any other diagnostic area appropriate to the participant's presentation, just as they would in a regular diagnostic interview. The member of the dyad designated as the interviewer for that participant conducted the interview, but the observer was allowed to ask additional questions at the end of the interview.
Clinician raters individually and autonomously entered the results of the diagnostic interview into a secure web-based electronic data capture system the Electronic Field Studies System, developed using the Qualtrics survey platform specifically designed by the WHO Field Studies Coordination Group for these studies Reed et al. Clinician Raters selected up to three diagnoses they thought were applicable for the service user they had seen, or indicated that no diagnosis was warranted, and then provided diagnostic evaluation information including a thorough review of the essential features of each selected diagnostic category.
This was done to ensure clinicians to include at least one of the diagnosis under study Schizophrenia or Other Primary Psychotic Disorder in Protocol 1, and a Mood, Anxiety and Fear-Related, or Stress-Related Disorder in protocol 2 , as well as the principal comorbid diagnoses within the same group of disorders or in other one.
In addition, clinician raters provided data on the severity of the service user's symptoms and their functional status, and answered questions about the clinical utility of the ICD diagnostic guidelines as applied to the particular service user. Accordingly, in the present study, the clinical utility of ICD diagnostic guidelines was evaluated using a 4-point Likert scale to rate the different elements of these domains through a self-reported questionnaire applied to a particular patient.
General characteristics of clinicians and patients were described using means and standard deviations for continuous variables and frequencies and percentages for categorical variables. All the variables were compared between protocols 1 and 2 , using independent sample t -tests or chi-square tests depending on the type of variables.
Comparisons of frequencies of each diagnosis provided by the interviewer and observer were made using McNemar tests. Kappa values were calculated in order to summarize the level of diagnostic agreement between interviewers and observers. Basic psychometric properties of the clinical utility measurement were obtained by calculating an exploratory factor analysis using likelihood maximum extraction, Oblimin rotation and Kaiser-Meyer-Olkin measure of sampling adequacy KMO , and a confirmatory model IBM SPSS Amos 21 for factorial or construct validity, as well as total and subtotal Cronbach's alphas for internal consistency or reliability.
Lastly, in order to analyze clinical utility information, the frequencies and percentages of each item were described for both interviewers and observers. Total means were compared between interviewers and observers using a t-test for independent samples. A total sample of 23 clinicians accredited to make diagnosis in Mexico 17 psychiatrists and six fourth- or fifth-year psychiatry residents evaluated 53 patients for Protocol 1 with psychotic symptoms and patients for Protocol 2 with mood, anxiety- or stress-related symptoms, without psychotic symptoms.
Table 1 presents the basic clinician characteristics. No differences by gender, age, or professional experience were found between interviewers and observers. Demographics and years of experience between interviewers and observers. Demographics: Patients in protocols 1 and 2.
Clinician rater dyads for the evaluation of each participant were assigned on the basis of a systematic sampling procedure using a list of clinicians available each day and taking into account their most recent role as observer or interviewer in order to maximize the variability of dyads and roles.
Accordingly, the percentage of repeated dyads was less than half the total number of dyads. Table 3 presents the Kappa's coefficients for the diagnostic guidelines of each ICD diagnostic group.
Agreement between interviewers and observers. The Scale of Clinical Utility of the ICD Mental and Behavioural diagnostic guidelines was first evaluated in terms of its construct validity factorial validity and reliability internal consistency. Table 4 presents the results of the exploratory factorial analysis of the scale, as well as internal consistency coefficients for the total and subtotal scores.
Scale of Clinical Utility: Factorial validity and internal consistency. These factors involved the same general type of items. Factor one grouped together items regarding the clinical utility of the guidelines for case identification and management, while factor two included items concerning the evaluation of implementation characteristics.
Cronbach's alphas were over. Scale of Clinical Utility: Confirmatory model. According to this scale, a high proportion of clinicians considered that all the diagnostic guidelines studied are quite or extremely useful Table 5. In general terms, the more frequent answer option was, by far, the one referring to a good clinical utility i. When adding the frequency of both answer options, the clinical utility of the ICD guidelines under study, given their implementation characteristics ease of use, goodness of fit, clarity, amount of time required, etc.
Reliable, clinically useful, and globally applicable diagnostic classification is an essential tool for reducing the treatment gap and the burden of disease attributable to common mental disorders in adulthood International Advisory Group for the Revision of ICD Mental and Behavioural Disorders, This is especially true in Latin American countries such as Mexico, where patients in need of care are not identified in a timely manner and only obtain treatment when their disorders are already very severe Borges et al.
Before discussing our results, several limitations of our study need to be considered. The sample is small, comprising a total of patients independently evaluated by a pair of psychiatrists and medical doctors in training. Moreover, the data are drawn from a single institution oriented towards research, which also serves as a teaching hospital.
The clinicians were psychiatrists and residents in training to become psychiatrists, who likely had high levels of training in comparison to the general population of clinicians.
Despite these limitations, the results have significant implications for the implementation of the ICD in Mexico and Latin-American countries. According to Cohen's criteria Cohen, , diagnostic agreement between raters using ICD guidelines can be rated as strong for Schizophrenia and Other Primary Psychotic Disorders, moderate for mood and stress-related disorders, and week -although acceptable- for anxiety and fear-related disorders.
This might be explained in part given such group of disorders was less common in the sample.
International Journal of Clinical and Health Psychology publishes manuscripts with a basic and applied emphasis, involving both theoretical and experimental areas contributing to the advancement of Clinical and Health Psychology. Papers including psychopathology, psychotherapy, behaviour therapy, cognitive therapies, behavioural medicine, health psychology, community mental health, sexual health, child development, psychological assessment, psychophysiology, neuropsychology, etc. On exception the Journal publishes articles on science evaluation. The manuscripts with samples of university students whose use is not clearly justified in the objectives of the study will not be considered. The manuscripts submitted to International Journal of Clinical and Health Psychology should not have been previously published, and should not be under consideration for publication elsewhere. All signing authors must agree on the submitted version of the manuscript. By submitting their manuscript the authors agree to relinquish their copyrights to the Journal for the duration of the editorial process.
Toggle navigation. A type 2 excludes note represents "not included here". A type 2 excludes note indicates that the condition excluded is not part of the condition it is excluded from but a patient may have both conditions at the same time. When a type 2 excludes note appears under a code it is acceptable to use both the code FF99 and the excluded code together. Symptoms, signs and abnormal clinical and laboratory findings, not elsewhere classified RR09 Symptoms and signs involving the circula
Provides clinical descriptions, diagnostic guidelines, and codes for all mental and behavioral disorders commonly encountered in clinical psychiatry. The book.
Classification of mental disorders
ICD GM is to be used for encoding in the outpatient and inpatient sectors. The currently valid version is effective from the beginning of a new year until the release of a new version. In the case of corrections during this period of validity you will be informed by our Newsletter. From 1 January , it has been used in Germany for the encoding of causes of death, thus forming a basis for internationally comparable official statistics of causes of death.
Хейл мог понять смысл лишь двух слов. Но этого было достаточно. СЛЕДОПЫТ ИЩЕТ… - Следопыт? - произнес. - Что он ищет? - Мгновение он испытывал неловкость, всматриваясь в экран, а потом принял решение.
Она точно окаменела. И закрыла. О Боже, пожалуйста. Не .
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